Document Detail


Continent urinary diversion: 10-year experience of Shriners Hospitals for Children in Chicago.
MedLine Citation:
PMID:  15503708     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To review long-term functional results, complications, and patient satisfaction in patients with a continent catheterizable urinary diversion. MATERIALS AND METHODS: A retrospective chart review and telephone satisfaction interviews were conducted. Bladder dysfunction was attributed to neurogenic bladder (n = 48: 23 spinal cord injury, 18 myelomeningocele, 4 sacral agenesis, 3 cerebral palsy), bladder exstrophy (n = 2), posterior urethral valves (n = 1), and other (n = 3). Patients underwent continent urinary diversion with either the Mitrofanoff principle (appendicovesicostomy, n = 47) or a Monti tube (ileovesicostomy, n = 8). Outcomes were assessed by chart review. Patient satisfaction was assessed by telephone interview and scored from 1 to 10 on a Likert-type scale. RESULTS: Between 1992 and 2003, 54 continent urinary diversions were performed on 17 boys and 37 girls. Mean age was 15.3 years (range, 7-21 years). An umbilical stoma was created in all patients. Seventy-three percent (40/54) and 47% (26/54) underwent concomitant bladder augmentation and urethral sling procedure, respectively. Mean follow-up was 2.5 years (range, 3 months to 10 years). Ninety-five percent (51/54) of patients were continent, and 5% (3/54) were incontinent from the umbilical stoma after one operation. All were compliant with intermittent catheterization. Complications included bladder calculi (15%; 8/54), stomal stenosis (9%; 5/54), stomal bleeding (5%; 3/54), small bowel obstruction (2%; 1/54), and superficial wound dehiscence (2%; 1/54). Seventy-three percent (40/54) of patients were available for telephone interview. Of these, 90% (36/40) reported satisfaction, and 10% (4/40) reported dissatisfaction; 93% (37/40) reported that they would recommend the procedure to others, whereas 7% (3/40) would not. CONCLUSION: In our series, continent urinary diversion with the Mitrofanoff principle or Monti tube is associated with high continence, compliance, and satisfaction rates and a low complication rate. An umbilical stoma was achievable in all patients. Our 10-year experience is consistent with other reported series and underscores the successful long-term outcome and durability of continent urinary diversions.
Authors:
Natakom N Chulamorkodt; Carlos R Estrada; Antonio H Chaviano
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of spinal cord medicine     Volume:  27 Suppl 1     ISSN:  1079-0268     ISO Abbreviation:  J Spinal Cord Med     Publication Date:  2004  
Date Detail:
Created Date:  2004-10-26     Completed Date:  2005-01-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9504452     Medline TA:  J Spinal Cord Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S84-7     Citation Subset:  IM    
Affiliation:
Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA. nchula1@vic.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Appendix / surgery
Bladder Exstrophy / surgery
Chicago
Child
Cystostomy* / adverse effects,  psychology
Female
Follow-Up Studies
Health Care Surveys
Hospitals, Pediatric
Humans
Male
Patient Satisfaction*
Postoperative Complications
Retrospective Studies
Treatment Outcome
Urethral Diseases / surgery
Urinary Bladder, Neurogenic / surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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